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VISUAL OUTCOMES IN CHILDREN WITH MALARIA

Cortical blindness is a well recognised neurological complication of cerebral malaria although most of the dysfunction usually resolves in a matter of weeks. Retinal changes in severe malaria also occur. These changes include retinal whitening. In a study performed in Malawi, Beare and colleagues demonstrate that retinal changes in malaria, especially macular whitening, do not appear to affect visual acuity after 1 month. This supports the hypothesis that retinal whitening is caused by reversible intracellular oedema in response to relative hypoxia. They conclude that permanent visual dysfunction after malaria is most probably a cortical phenomenon. See p 321

PREOPERATIVE COUNSELLING FOR CATARACT PATIENTS

Elder and Suter investigated the questions patients undergoing cataract surgery wish to have answered. A written questionnaire was answered by 195 patients before cataract surgery. In this study patients were most concerned about benefits and risks, even small risks, associated with cataract surgery. There were few differences between the sexes and between those having first or second operations. The authors suggested that written information should be provided to patients undergoing cataract surgery to reinforce verbal informed consent. See p 331


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ANAESTHESIA FOR CATARACT SURGERY

There has been a recent trend away from regional block anaesthesia to topical anaesthesia for cataract surgery. Friedman and coworkers interviewed patients undergoing cataract surgery at the Wilmer Eye Institute. They were asked to select their preference for the type of anaesthetic management strategy. Given the choice of four different anaesthetic strategies the majority of subjects preferred block anaesthesia to topical anaesthesia. Moreover, patients chose to have oral sedation rather than intravenous sedation. The authors suggest that patients may prefer anaesthesia management different from what is currently being offered to them. See p 333

INTRAVITREAL TRIAMCINOLONE WITH PHOTODYNAMIC THERAPY FOR AGE RELATED MACULAR DEGENERATION

Currently, photodynamic therapy has been shown to be effective in the short term for treatment of choroidal neovascularisation. Similar studies of triamcinolone intravitreal injections have shown comparable short term efficacy. Rechtman and coworkers report a small study of patients undergoing combined intravitreal triamcinolone and photodynamic therapy for age related macular degeneration. In this study this combined therapy was found to be relatively safe and had reasonable results for regions with some of the classic components of subfoveal choroidal neovascularisation associated with age related macular degeneration. See p 344

ASTIGMATISM FOLLOWING KERATOPLASTY FOR KERATOCONUS

Astigmatism is common in all corneal transplant patients and is a particular problem associated with patients undergoing keratoplasty for keratoconus. Lim and coworkers present a study of 10 eyes of 10 patients in which progression of keratoconus in the host cornea late after penetrating keratoplasty was documented. They demonstrate that a large astigmatic change occurs where the flat axis of astigmatism passes through an area of host thinning visible on slit lamp. This can be effectively treated with compressive resuturing performed in the area of host thinning. See p 371

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